A relapse is a disappointing moment in the course of any chronic disease. It may come after a period of hard work to successfully manage your symptoms. But relapse is a fact of life for many people dealing with lifelong medical, mental, and behavioral health issues. But what about alcohol relapse? How common is it, and does relapse mean your efforts have failed?
Relapse is something people in recovery often worry about, and it’s good to create a prevention plan to guard your sobriety against it. Still, a relapse may happen, so it’s important to know what you can do about it and how to prevent one in the future.
A relapse is a term used in medicine to describe a return or worsening of symptoms that had been under control during a disease. When it comes to addiction, a relapse is a term that refers to a return to drug or alcohol use. Addiction relapse comes after a period of abstinence, which involves a return to unhealthy addictive behavior. If someone has alcohol use disorder (AUD) and achieved a period of abstinence, one drink may be considered a slip or a lapse.
But a relapse would be if they returned to drinking compulsively. Addiction is identified by compulsive drug or alcohol use despite harmful consequences in your life. Addiction is a disease that affects the reward center of the brain and can cause your brain to treat drug use like a life-sustaining activity. Someone with an addiction has lost control of their substance use habits, usually because their brain is creating powerful cravings and compulsions to drink again.
A relapse is often seen as the end to an attempt at sobriety, but it is much more complicated than a failed attempt. Dr. Alan Marlatt developed a therapy called cognitive behavioral therapy for treating alcohol use disorder. According to Marlatt’s approach to relapse prevention, relapse is seen as a stage in a transition. In Marlatt’s relapse prevention model, a relapse starts in the mind, and actually taking a drink or a drug is the final step in a multistage relapse.
Relapse begins with a trigger or high-risk situation, which is a situation that causes you to crave substance use. The next step is your coping response. An ineffective coping response leads to a decrease in self-efficacy. That can lead to a lapse and an increase in the likelihood of a full relapse. An effective coping response leads to improved self-efficacy and a lowered likelihood of relapse.
Since a relapse starts in your mind, it actually occurs in multiple stages. The first stage is called an emotional relapse. During the emotional stage of a relapse, the idea of using drugs or alcohol again may not be conscious.
Instead, emotional issues like isolation, anxiety, depression, stress, and a lack of social support may increase your risk of a relapse. If these emotional issues are effectively managed, it could lead to a mental relapse. This is often seen as the most critical stage. Relapses may be easier to avoid if their emotional roots are managed.
During a mental relapse, you start to consciously think about using again. It may not start with contemplating using again. Instead, you may think about the places you used to use or the people who you used to drink with. You may start to rationalize drinking or using drugs again. You may start to think you can control it this time or that your hard work has earned you a drink. If this is left unaddressed, a physical relapse is likely.
Physical relapse is the moment you actually drink again. Though it’s the most visible stage and often thought of as the only stage, it’s actually the final step in a multistage relapse. A single lapse can lead to the abstinence violation effect, which is a phenomenon in which a single drink dramatically increases the likelihood of more drinking and a full-blown relapse.
According to the National Institute on Drug Abuse (NIDA), a relapse isn’t an indication that addiction treatment has failed. Addiction is a chronic disease that affects the brain. Like other chronic conditions, relapse is relatively common.
People who achieve sobriety and a period of abstinence relapse in 40% to 60% of cases. However, relapse is often seen as part of the recovery process, and many people relapse once or several times before they eventually reach long-term sobriety. According to the stages of the change model, relapse is a stage in the cycle that starts it over.
It’s important to remember that relapse isn’t guaranteed. Some people achieve lasting sobriety after their first attempt at treatment. However, it’s worth noting that a relapse doesn’t mean the work you put into treatment has failed. All of what you learned can be taken into the next attempt at abstinence. A relapse signals that treatment needs to be revisited, your relapse prevention plan should be revised, or you should strengthen your system of support.
According to Marlatt’s method, relapse prevention has to do with self-efficacy and developing effective coping strategies. Coping is the key to preventing the relapse. Maintaining your sobriety may involve avoiding known causes of triggers and high-risk situations. For instance, people with alcohol use disorder often stay away from bars altogether. However, it’s impossible to avoid all triggers, especially ones that are inborn. In the relapse prevention model, it’s your response, not the trigger, that leads to the relapse.
Developing effective coping responses can be done in many ways. One of the most important ways to cope is by connecting to other people who can help you. If you’ve been through a treatment program, you’ve learned the importance of accepting help from others, including doctors, therapists, and peers.
After treatment, groups like Alcoholics Anonymous and Narcotics Anonymous can help connect you with other people with similar problems and goals. After treatment, it’s important to develop a solid support system that involves sponsors, therapists, family members, and friends who can offer you care and accountability.
Marlatt’s model shows there are many interventions throughout each stage of a relapse that can help you avoid returning to alcohol use. Many relapses start with some kind of lifestyle imbalance. This could be stress at work, a sense of loneliness when you return to an empty house, anxiety disorders, and countless other potential complications life can throw at you. Stress can often cause your brain to create compulsions to drink in order to soothe anxieties. But meeting those life imbalances head-on can help resolve the issue before it progresses to a relapse.
If you start to feel urges to use again, you can respond by taking extreme precautions. Talk to a friend or sponsor, speak to a therapist, and remove yourself from a situation in which you could end up drinking. If you progress to an actual lapse, there are some interventions you can take to prevent a full return to active addiction. You may stay with a friend that can keep you accountable. Recognize that a lapse greatly threatens your sobriety; it’s not just a one-time thing—it could result in a full relapse.
Self-efficacy is a key component of relapse prevention. Self-efficacy is a complex idea that essentially boils down to your belief that you can overcome challenges and accomplish tasks. But simply “believing in yourself” may be an oversimplification.
Psychologist Albert Bandura thought that self-efficacy was an influential factor in many aspects of a person’s life. He said, “Self-efficacy beliefs determine how people feel, think, motivate themselves and behave.” Marlatt wrote in his paper on relapse prevention that self-efficacy was a person’s “mastery over his or her behavior.”
Different things can help to build up your self-efficacy or tear it down, including your responses to a high-risk situation, craving, or trigger. One of the best ways to increase self-efficacy in through what Bandura called “mastery experiences.”
Essentially, these are moments you had success that increase your belief that you can have success in future challenges. For that reason, resisting a relapse can increase self-efficacy, and giving into relapse can have the opposite effect. You can also build up your self-efficacy through therapy, especially cognitive-behavioral therapy.
Connecting with others may also help build up your self-efficacy. Finding fulfilling relationships that enrich your life and strengthen your support system may be the key to long-term sobriety. On the other hand, isolation is an enemy of mental health and sobriety.
Whether you’re struggling to maintain your sobriety or you feel like a recovery rockstar, you should connect to a community. Groups like Alcoholics Anonymous can connect you to other people that share the same goals and understand your challenges.
However, if you’re struggling, don’t hesitate to talk to a therapist or a professional who can help you protect your sobriety.